What is addiction?

By Jamie Biggs jbiggs@courier-tribune.com

Monday

Sep 10, 2018 at 12:01 AMSep 10, 2018 at 8:03 PM

Editor’s note: Every Tuesday, our series, “Opioids in Randolph: Rising to the Challenge,” will take a deep-dive into the opioid crisis that is affecting so many lives here and throughout the United States. Today we examine addiction and its contributing factors.

ASHEBORO — The Diagnostic and Statistical Manual of Mental Disorders defines addiction as a pattern of substance use leading to clinically significant impairment or distress.

Symptoms of addiction vary, but it’s commonly characterized by a loss of control, failed attempts to quit, tolerance and withdrawal.

It affects the brain and body.

And like with most diseases, addiction can result in other illnesses, as well as death.

“It’s a chronic disease,” said Kendall Phillips, a public heath educator with the Randolph County Health Department. “If you relate it to something like heart disease, people know part of heart disease is that there are lifestyle influences, and know that something like a heart attack is a symptom of heart disease. You can be in recovery, but a relapse is going to be like that heart attack — it’s a part of the disease.”

For years, alcoholism has been widely recognized as a disease — triggered by genetic predisposition, psychological factors (stress, depression, anxiety) and environmental influences.

“One person may have a drink and be okay, and another person may have a drink and immediately start craving a second one,” explained Major Bradley Beck, with Randolph County Emergency Services.

But opioid addiction has not had the same understanding, although the same factors come into play for opioids, whether it be a prescribed painkiller, such as oxycodone, or a drug purchased illegally, such as heroin or fentanyl.

However, as the epidemic escalates, people are beginning to realize that opioid addiction is just as much a disease as alcoholism, health educators say.

Impact of addiction

As seen in monthly overdose data gathered by Chief Donovan Davis with Emergency Services, addiction knows no age or gender.

So far in 2018, a suspected total of 257 patients have overdosed on opioids in Randolph County.

Of these individuals, 150 were male, 106 were female and one was unknown.

The youngest to die from an overdose was an 18-year-old, while the oldest was 65 years old.

Addiction isn’t a problem only impacting the poor or the rich, either.

“Across the board, what data is showing is that addiction does tend to be a little more common in our low income areas,” Phillips said. “Generally speaking though, it is affecting people of all social statuses.”

“A lot of people have a misconception that it’s a problem with the youth,” added Phillips, “but really what our data is showing is that it’s really impacting the older demographic. Ages 55 to 65 is the most rapidly increasing age group.”

How do people become addicted?

The increase in the numbers of those addicted to opioids has skyrocketed in recent years, likely due in part to prescribed painkillers becoming more difficult to obtain.

The STOP Act, a law passed in June 2017, was designed to reduce the inappropriate prescribing of opioids.

The law limits the number of days worth of opioids permitted to be prescribed at once, as well as requires prescribers to check with the N.C. Controlled Substances Reporting System to review the patient’s prescription history 12 months back.

This could explain the increase of addiction in older age groups, according to Beck.

“The amount of prescription opioids you can get has decreased,” said Beck. “So a lot of our first-time users are going to be your middle-aged men who have been on oxycodone for four or five years for a back injury, and now the doctor says, ‘I can’t legally give you that amount anymore.’ ”

It doesn’t always happen this way though. There are multiple factors that can put a person at risk of addiction.

Genetic predisposition, psychological factors — stress, depression, anxiety — and environmental influences are all factors that may increase the odds of addiction.

“There is a pretty significant genetic link when it comes to having a genetic predisposition to addiction,” said Phillips. “Along those lines is mental health. Mental health plays a pretty big role in genetics. A lot of the times you’ll hear the question, ‘Was it mental health or substance abuse?’ ”

According to Phillips, it’s not known which factor may contribute to the highest number of addiction cases, but it is evident that the earlier a person is introduced to opioids, the higher the risk of addiction becomes.

“We do know that the majority of people who have a substance use disorder tried their first substance before age 18, and that the earlier you start engaging in substance use, the more likely you are to have a substance issue later on.”

Phillips added that fewer mental health resources exist for older generations, which may contribute to the rising number of overdoses and cases of addiction in ages 55-65.

From prescriptions to heroin

When prescriptions are discontinued, addicts may turn to buying their drugs on the street, as indicated by Beck and Phillips.

Those who are taking prescribed opioids will generally begin by looking for other pills to replace the legal drugs that are no longer as readily available to them.

“That’s where it starts, based off of people that I’ve spoken to,” said Phillips. “But pills are way more expensive than heroin, so that’s when it turns to heroin — whenever money runs out for the pills.”

Heroin tends to be a more dangerous drug than prescription opioids, as it has the potential to contain substances that can cause even more harm to a person, such as fentanyl.

“Fentanyl is being cut into heroin, and because fentanyl can be really cheaply made and added, you get bigger batches that last longer and give a stronger high,” said Phillips. “And that’s what’s killing people — the fentanyl.”

Addiction and the brain

Everyone has opioid receptors in their brain, as well as in tissues, organs, and muscles throughout the body, but not everyone that takes opioids becomes addicted to them.

According to the National Institute on Drug Abuse, many people assume that those who become addicted lack willpower or morals, but that assumption has proven to be inaccurate.

Opioids — even those prescribed by a doctor — change the way the brain works, making it harder for a person to quit, even if they want to.

When a person uses, the brain’s reward circuit is impacted, and the euphoric feeling received motivates a person to use again in order to experience the same “reward.”

Prolonged use will result in a person becoming more tolerant of a drug, which leads to an individual needing to use more of the drug to achieve the same feeling.

Addicts are not people who set out to become addicted.

The drugs left them without a choice.

“These are people,” said Phillips. “There are people that love them. They deserve to live and be productive members of society, just like everyone else.”

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